Namibia CDC-RFA-JG-25-0093 Final NOFO for Publication v2.pdf

Division of Global HIV and Tuberculosis

Notice of Funding Opportunity

Application due February 20, 2025

Strengthening the government of Namibia’s health information systems (HIS) to improve public health programs under the President’s Emergency Plan for AIDS Relief

(PEPFAR)

Opportunity number: CDC-RFA-JG-25-0093

Contents Before you begin 3

Step 1: Review the Opportunity 4

Basic information 5

Eligibility 8

Program description 10

Step 2: Get Ready to Apply 31

Get registered 32

Questions 33

Step 3: Prepare Your Application 34

Application contents and format 35

Step 4: Learn About Review and Award 46

Application review 47

Award notices 54

Step 5: Submit Your Application 55

Application submission and deadlines 56

Application checklist 58

Step 6: Learn What Happens After Award 60

Post-award requirements and administration 61

Contacts and Support 68

Contents 2

Before you begin If you believe you are a good candidate for this funding opportunity, secure your SAM.gov and Grants.gov registrations now. If you are already registered, make sure your registrations are active and up-to-date.

SAM.gov registration (this can take several weeks) You must have an active account with SAM.gov. This includes having a Unique Entity Identifier (UEI).

See Step 2: Get Ready to Apply

Grants.gov registration (this can take several days) You must have an active Grants.gov registration. Doing so requires a Login.gov registration as well.

See Step 2: Get Ready to Apply

Apply by the application due date Applications are due by 11:59 p.m. Eastern Time on February 20, 2025.

To help you find what you need, this NOFO uses internal links. In Adobe Reader, you can go back to where you were by pressing Alt + Left Arrow (Windows) or Command + Left Arrow (Mac) on your keyboard.

Before you begin 3 https://sam.gov/ https://grants.gov/

Jump to a step

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1:

Review the Opportunity

In this step

Basic information 5

Eligibility 8

Program description 10

Basic information Centers for Disease Control

Global Health Center

Division of Global HIV and Tuberculosis

Reducing HIV and TB incidence and mortality in global settings through data-driven programs and strengthened public health systems.

Have questions?

See Contacts and Support.

Key facts

Opportunity name:

Strengthening the government of Namibia’s health information systems (HIS) to improve public health programs under the President’s Emergency Plan for AIDS Relief (PEPFAR)

Opportunity number:

CDC-RFA-JG-25-0093

Announcement type:

New

Assistance listing:

93.067 Global AIDS

Program

Key dates

Application deadline:

February 20, 2025

Expected award and start date: September 30, 2025

We will inform you of your application status by the end of August 2025.

See other submissions for other time frames that may apply to this

NOFO.

Summary This NOFO will provide technical assistance to the government of the Republic of Namibia (GRN) to strengthen and implement health information systems (HIS), monitoring and evaluation (M&E) strategies, and surveillance activities.

The goal of this work is to improve the quality, access, and use of data to control the HIV and TB epidemics.

This NOFO also supports developing innovative, efficient, and sustainable data systems. This work aims to enhance HIV and TB programs and respond to changing data needs by working with the Ministry of Health and Social Services (MOHSS), the Namibia Institute of Pathology (NIP), and other stakeholders.

To meet the goals of this NOFO, strategies may include:

• Improving data access and use in and across various laboratory, community, and facility-based systems.

• Enhancing MOHSS-led surveillance systems.

• Strengthening MOHSS’s ability to store and access health data centrally.

• Improving unique identification for health records.

• Introducing technology to automate and increase efficiency.

• Providing technical assistance and capacity building for GRN staff.

• Improving data quality, including timeliness, completeness, and accuracy, across HIS and surveillance systems.

You will be expected to assess and strengthen the existing MOHSS and NIP infrastructure, systems, and capacity.

Step 1: Review the Opportunity 5

We also expect HIS and surveillance systems that improve HIV and TB data quality, access, and use to monitor and evaluate program outcomes and to inform national policies, guidelines, and public health response.

Funding details Type: Cooperative agreement

Expected total NOFO funding for Year 1: $5,000,000 This is the expected total Year 1 funding for all awards made under this

NOFO.

Expected number of awards: 1 to 3 The number of awards is subject to available funds and program priorities.

Exact amounts for each award under this NOFO will be determined upon award.

We plan to award projects for five 12-month budget periods for a five-year period of performance.

Funding strategy

Funding amounts We encourage you to apply for the expected total NOFO funding for Year 1.

You may not request more than this amount.

Funding amounts for years two through five will be set at continuation. We will continue funding based on:

• Availability of funds.

• Evidence of satisfactory progress, as documented in your required reports.

• The determination that continued funding is in the best interest of the federal government.

Component funding

Overview

We fund all President’s Emergency Plan for AIDS Relief (PEPFAR) cooperative agreements using component funding.

Component funding allows us to provide funding as it becomes available. To do so, we fund sets of activities by quarter and project.

CDC may fund one or more of your components to start the budget period, and then consider other components based on available funding later.

Step 1: Review the Opportunity 6

Setting up components

You must set up your components in your application. While preparing your application:

• Review the expectations for year one activities in the strategies and activities section.

• Group your activities under the following anticipated components. Only include the activities planned for year one.

◦ Component 1: COP Quarter 1 Targets and Activities.

◦ Component 2: COP Quarter 2 Targets and Activities.

◦ Component 3: COP Quarter 3 Targets and Activities.

◦ Component 4: COP Quarter 4 Targets and Activities.

◦ Component 5: COP Additional Targets and Activities.

◦ Component 6: Emerging public health priorities (buffer component if needed).

For information on how to incorporate component funding into your application, see the following sections:

• Budget narrative

• Component funding instructions for SF-424A

PEPFAR Local partner funding preference This NOFO includes a funding preference for local partners. Your organization will receive 15 extra points during the selection process if you provide sufficient documentation demonstrating you meet the PEPFAR local partner definition.

Step 1: Review the Opportunity 7

Eligibility Statutory authority This program is authorized under:

• The United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003, Public Law 108-25 (22 U.S.C. 7601, et seq.).

• The Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, Public Law 110-293.

• The PEPFAR Stewardship and Oversight Act of 2013, Public Law 113-56.

• Public Health Service Act (42 U.S.C. 242I).

Eligible applicants This is a fully competitive NOFO, and eligibility is unrestricted. Any and all types of organizations are eligible and encouraged to apply, including but not limited to those listed below.

• State governments.

• County governments.

• City or township governments.

• Special district governments.

• Independent school districts.

• Public and state-controlled institutions of higher education.

• Native American tribal governments (federally recognized).

• Public housing authorities and Indian housing authorities.

• Native American tribal organizations, other than federally recognized tribal governments.

• Nonprofits having a 501(c)(3) status, other than institutions of higher education.

• Nonprofits without 501(c)(3) status, other than institutions of higher education.

• Private institutions of higher education.

• For-profit organizations other than small businesses.

• Small businesses.

• Foreign or non-U.S. based entities.

Step 1: Review the Opportunity 8

Other required qualifying factors

Delivery location While any type of organization may apply, you must conduct the project in Namibia.

Responsiveness criteria We will review your application to make sure it meets these requirements.

These are the basic requirements you must meet to move forward in the competition. We won’t consider an application that:

• Is from an organization that doesn’t meet eligibility criteria. See requirements in eligibility.

• Is submitted after the deadline.

• Proposes research activities. See 45 CFR 75.2 for the definition of research.

• Requests more funding than the expected total NOFO funding for Year 1.

• Exceeds the 20-page limit for the project narrative (see the project narrative section for what counts toward the page limit).

• Is not in English.

• Includes a budget or budget narrative that uses a currency other than U.S. dollars.

• Does not respond to and is outside the scope of this NOFO.

See the application checklist to understand your application requirements.

Application limits We do not limit the number of applications an organization may submit.

Cost sharing and matching funds This program has no cost-sharing or matching funds requirement. We will not consider cost-sharing fund contributions during your application review.

However, if you submit voluntary cost-sharing funds and we fund your project, we will require you to report on these funds.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 9 https://www.ecfr.gov/current/title-45/part-75#p-75.2(Research)

Program description Background overview and related work HIV in Namibia: recent achievements Namibia has made great progress towards controlling the HIV epidemic by:

• Nearly achieving the UNAIDS 95-95-95 targets. Namibia is currently at 93-95-98.

• Achieving 90% antiretroviral therapy (ART) coverage for the estimated 230,000 people living with HIV.

Current priorities This NOFO aims to achieve the 95-95-95 targets and maintain epidemic control while making sure that public health systems are built and sustained for broader public health impact. Priorities include:

• Maintaining the treatment cohort at undetectable viral load levels.

• Identifying and preventing new infections.

• Investing in public health systems and response.

High-quality and relevant data are critical to monitor and improve program interventions and outcomes while informing national policies, guidelines, and public health response. Access to such data requires innovative, sustainable, and efficient HIS and surveillance systems.

The state of Namibia’s health information systems Previous investments in health systems have provided a foundation for the many data and information systems currently in use, including:

• Individual-level HIV systems:

◦ Quantum electronic patient monitoring system (ePMS).

◦ PTracker.

◦ Cervical cancer tracker.

◦ Index testing tracker.

◦ Laboratory information system (LIS).

• Aggregate systems such as MOHSS’s district health information software 2 (DHIS2) core for routine aggregate reporting.

Step 1: Review the Opportunity 10

Many of the health programs already have digitized data, and several are quite mature. However, these disparate systems have limited or no interoperability or data exchange. The data is often accessed and reviewed in silos.

Facility and national-level investments Despite these challenges, the broader MOHSS’s HIV/TB program has collected, reported, and used much of the necessary data to inform and monitor the programs.

Data collected at the facility level is retrospective and mostly supported by non-MOHSS data clerks. When healthcare workers or non-data staff are expected to use HIS, it often results in challenges with data completeness and use.

At the national level, PEPFAR has assisted the MOHSS invest in developing a national unique health identifier and master patient index. These are currently being piloted, and we expect you to work with MOHSS to advance their use, link patient data across systems, and improve patient management and the effective use of limited resources.

PEPFAR has also supported establishing a national data warehouse (NDW) to improve data integration, access, analytics, and use through health information exchange (HIE) from disparate systems. This project is still new, with limited updates, data access, and integration.

Many of these investments are fragile and heavily dependent on PEPFAR funding and technical assistance. By the start of this award, we expect the treatment electronic medical record (EMR), including Quantum ePMS, to transition to a new platform and be close to fully implemented in all facilities.

Supporting a strategic, sustainable HIS in Namibia Through this NOFO, you will work closely with MOHSS to review and evolve HIV/TB systems and technologies toward a more strategic, sustainable, and integrated HIS ecosystem responsive to Namibia’s current and changing health needs. This work will include:

• Informing and implementing the GRN’s eHealth strategy.

• Building MOHSS’s capacity in HIS and in necessary infrastructure.

• Supporting data system evolution and integration with existing and new technologies.

• Strengthening data use and M&E strategies.

• Supporting surveillance and survey implementation.

Step 1: Review the Opportunity 11

A key lesson we’ve learned is the need to work closely with the MOHSS at every stage of the process. This includes making sure that the project and overall HIS strategies cover governance, capacity development, operations, and financial sustainability through the MOHSS. This work will require expertise in HIS governance, project management, and relationship building.

Purpose The purpose of this NOFO is to improve health outcomes in Namibia by further developing and improving data integration of health information systems focused on patient management and program improvement for HIV/ TB while supporting public health surveillance and response mechanisms.

This involves:

• Strengthening HIS capacity including linkage and data exchange to existing HIS.

• Strengthening data use for decision-making.

• Ensuring alignment with national HIS strategies.

• Building capacity to transition system ownership to the MOHSS.

Approach Program logic model The following logic model includes the expected strategies under this NOFO.

The logic model also includes the program’s expected outcomes. Outcomes are the results that you intend to achieve and usually show the intended direction of change, such as increase or decrease.

The asterisked ( * ) outcomes are those we expect you to achieve or substantially contribute to during the five-year period of performance. You must report on these outcomes.

Not all outcomes apply to all strategies. You will use these outcomes as a guide for developing performance measures.

Step 1: Review the Opportunity 12

Table: Strategies and outcomes

Strategies Short-term outcomes Intermediate outcomes Long-term outcomes

Strategy 1: Support MOHSS to develop, implement, and maintain HIS and technological solutions for HIV/TB patient and program management and improvement.

Strategy 2: Support MOHSS in developing, implementing, and evaluating the country’s eHealth strategies, governance, policies, architecture, and HIS standards.

Strategy 3: Develop health informatics capacity of MOHSS professionals.

Strategy 4:

Strengthen data use for decision-making and effective HIV/TB program management at all levels.

Strategy 5: Support the design and implementation of survey and routine surveillance systems to monitor the HIV/TB epidemic and identify public health threats.

Increased coverage of EMR system to digitize patient records for HIV/TB program management.*

Increased data exchange and interoperability of EMRs.*

Increased use of unique national health identifiers to link HIV/TB records.*

Increased clarity on eHealth roadmap for disparate systems.*

Increased access to HIS frameworks for system improvement.*

Increased use of data standards for information exchange between HIS.*

Increased MOH capacity to effectively manage and use HIS.*

Increased access to tools for management and analysis of HIV data systems.*

Increased analytic capacity and use of HIV/TB data systems.*

Improved HIS program management for better patient outcomes.*

Increased data exchange between

HIS.*

Reduced reliance on partner support for HIS management.*

Increased use of data to inform program interventions, policies, and patient management.*

Improved ability to detect, respond, and prevent outbreaks of new infections.*

Improved use of routine data for surveillance activities to inform policies and programs.*

Improved public health response for

HIV/TB.

Reduced HIV-related morbidity and mortality.

Improved sustainability of HIS system to manage HIV/TB program needs.

Increased resiliency of HIS to meet ongoing public health data needs.*

Improved MOHSS capacity to effectively implement a sustainable HIS aligned with national and international standards.*

Increased MOHSS leadership in HIV/TB response through enhanced HIS oversight and management.*

Step 1: Review the Opportunity 13

Strategies Short-term outcomes Intermediate outcomes Long-term outcomes

Improved availability of surveillance systems to address emerging public health threats.*

Additional information on outcomes in the logic model:

• Increased use of unique national identifiers to link records includes linking records across different service delivery points or systems.

• Increased clarity on eHealth roadmap for disparate systems includes realistic plans for addressing disparate systems.

• Increased access to HIS frameworks for system improvement includes:

◦ eHealth strategies.

◦ Governance infrastructure.

◦ Standard operating procedures, policies, and HIS standards.

• Increased MOH capacity to effectively manage and use HIS includes system deployment and maintenance.

• Improved availability of surveillance systems to address emerging public health threats:

◦ Surveillance systems include use of surveillance reports, surveys, system design and implementation, and data to address emerging threats.

◦ Addressing emerging threats includes identifying a threat and understanding its epidemiology to create an action plan.

Strategies and activities This section elaborates on the strategies described in the logic model by providing expected activities and details about how you expect to implement your program.

The following are strategies and the required and optional activities under this NOFO. You may also propose additional related strategies and activities to achieve the expected outcomes.

Step 1: Review the Opportunity 14

Strategy 1: Support MOHSS to develop, implement, and maintain HIS and technological solutions for HIV/TB patient and program management and improvement.

Required activities

• Support developing and strengthening various national eHealth and information technology (IT) architecture to improve data access, exchange, and use.

• Support implementing national unique identifier to reduce duplication of records and improve patient-tracking.

• Support developing and implementing national data repositories.

• Expand and scale EMR interoperability with laboratory, pharmacy, DHIS2, dashboards, help desk, and other systems to improve clinical responsiveness for multi-directional reporting among multiple platforms and devices.

• Support the development of a national laboratory repository system.

• Provide technical expertise, mentorship, and leadership in designing, developing, and implementing sustainable and interoperable individual-level HIS.

• Consult and provide expert technical assistance to the MOHSS on system upgrades, sustainability, and effectiveness, including establishing governance and standard operating procedures for system upgrades and enhancements.

• Develop and implement efficient data processing, migration, and management processes at all levels.

• Expand and scale innovative power and connectivity solutions to advance timely facility-level data exchange and storage in compliance with Namibia’s national IT architecture.

• Develop tools to efficiently manage data use agreements, IT documentation, and meta-data code for sub-systems archived within the

NDW.

• Provide technical expertise to assess HIV and TB individual-level systems data and information gaps and guide MOHSS on system adjustments to respond to those gaps.

• Provide technical expertise in systems documentation and plans for sustainability.

Step 1: Review the Opportunity 15

Optional activities

• Develop public-private partnerships with technology companies to use resources, technology, and innovations in support of key epidemic control priorities.

Strategy 2: Support MOHSS in developing, implementing, and evaluating the country’s eHealth strategies, governance, policies, architecture, and HIS standards.

Required activities

• Support updating and revising the national eHealth strategy with a clear implementation plan that covers existing disparate systems.

• Provide expert scientific consultation and leadership to Namibia’s MOHSS to review, adopt, and implement international IT standards to improve HIS data quality, HIE, interoperability, security, privacy, and use.

• Develop standards and standard operating procedures for data access and sharing.

• Support the development of national policy and frameworks for implementing unique patient identifiers and identification.

• Support the development of country project management and M&E plans and protocols for HIS implementation.

• Develop an evaluation framework including methods, tools, and reports for eHealth strategies, systems, and policies.

Strategy 3: Develop health informatics capacity of MOHSS professionals.

Required activities

• Assess informatics capacity to support eHealth needs.

• Build MOHSS capacity in HIS development, maintenance, and interoperability.

• Build IT project management capacity for national data systems.

• Build MOHSS HIS staff and local partners’ capacity to work together to solve HIS problems using outcome-based workforce development methods.

• Develop and deliver courses on core informatics and HIS content to designated healthcare and public health professionals, including leadership.

Step 1: Review the Opportunity 16

• Increase awareness and familiarity with global HIS best practices and appropriate digital goods that can be made relevant to Namibia in advancing its health priorities.

• Strengthen MOHSS and other PEPFAR implementing partners’ capacity on sustainable open-source tools and key information systems.

• Share models and frameworks for developing in-country informatics and HIS capacity.

• Enhance data management, analysis, and use capacity within MOHSS and implementing partner staff.

• Build local competency and capacity in maintaining data and systems security and privacy.

Optional activities

• Develop and validate competencies for a variety of informatics and HIS professionals.

• Support HIS workforce strategy and position planning and development.

Strategy 4: Strengthen data use for decision-making and effective HIV/TB program management at all levels.

Required activities

• Support developing new processes to ensure the completion of information and data loops: from data collection through analysis, visualization, to feedback and use of results.

• Develop data analysis and visualization tools for use across levels and teams to promote ownership and use.

• Support healthcare providers’ capacity to use health data and information for person-centered care.

• Introduce machine learning or automated procedures that improve linking patient records from various sources to increase the volume and quality of data available for analytics.

Strategy 5: Support the design and implementation of survey and routine surveillance systems to monitor the HIV/ TB epidemic and identify public health threats.

Required activities

• Design and implement surveys and surveillance systems with MOHSS.

• Advise on sustainable and effective solutions for surveillance data collection, analysis, and use.

Step 1: Review the Opportunity 17

• Provide MOHSS and implementing partners with technical assistance and capacity-building in the design, implementation, and use of survey and surveillance systems.

• Support MOHSS and implementing partners in using routine data for surveillance activities to inform public health response.

To support the purpose of this NOFO, you are expected to provide copies of and/or access to all data, software, tools, training materials, guidelines, and systems developed under this NOFO to Ministry of Health and other relevant stakeholders, including HHS/CDC, for appropriate use consistent with underlying authorities.

Epidemic control activities In coordination with the Global Health Security and Diplomacy (GHSD) Bureau at the U.S. Department of State, and as part of PEPFAR, CDC works with host country governments and other partners. Together, we assess the needs of each country and design a plan for assistance that fits within the host nation’s strategic plan.

We consider a national HIV epidemic to be under control when:

• The number of HIV-related deaths is declining, and

• The number of new infections is less than the number of deaths.

Controlling the epidemic does not mean that HIV will be eliminated. Instead, it means that the number of people with HIV in the population is decreasing. If new infections or death rates increase, this means the epidemic is no longer under control.

Our work doesn’t end when we reach epidemic control; we must sustain the gains. During your award we may ask you to conduct additional activities to reach and maintain epidemic control, consistent with the scope of this NOFO and the related policies below. This may include:

• Improving prevention, testing, and treatment efforts for HIV/AIDS, TB, sexually transmitted infections (STI), and related opportunistic infections, especially among vulnerable, key, and priority populations as defined in PEPFAR’s annual Country/Regional Operational Plan (COP/ROP) Guidance.

• Promoting sustainable, country-led approaches to managing HIV/AIDS and TB and empowering national and local partners to take the lead in designing and conducting high-quality and cost-effective programs. This could involve forming new partnerships with private, public, local, and multisector entities that can complement and expand the reach of existing programs.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 18 https://www.state.gov/reports-pepfar/

• Improving and expanding laboratory, surveillance, and information systems and using the PEPFAR platform for broader disease surveillance and public health programs in ways that align with PEPFAR goals and initiatives.

• Enhancing efforts to prevent, detect, respond to, and treat other diseases affecting people living with or at risk of HIV.

Related policies If awarded, any activities you conduct must follow the directions in:

• Reimagining PEPFAR’s Strategic Direction: Fulfilling America’s Promise to End the HIV/AIDS Pandemic by 2030.

• PEPFAR’s annual COP/ROP Guidance and approved COPs/ROPs.

• Similar forthcoming strategy, guidance, or planning documents that are consistent with relevant laws.

Geographic focus The geographic focus of this program may change during the period of performance, based on the burden of disease and changing program and PEPFAR priorities.

Outcomes We expect you to achieve or substantially contribute to the outcomes asterisked ( * ) in the logic model by the end of the five-year period of performance. You will be expected to report on these outcomes.

Focus populations The focus populations for this NOFO include:

• Healthcare workers and laboratorians.

• Health information specialists.

• Public health managers who use data for evidence-based decision-making.

• MOHSS officials.

• Those who will benefit from improved HIS and surveillance systems, including populations at risk for or living with TB/HIV, such as:

◦ Pregnant and breastfeeding women.

◦ Children.

◦ Other applicable priority populations.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 19 https://www.state.gov/wp-content/uploads/2022/09/PEPFAR-Strategic-Direction_FINAL.pdf https://www.state.gov/wp-content/uploads/2022/09/PEPFAR-Strategic-Direction_FINAL.pdf

Equal opportunities This NOFO, including funding and eligibility, is not limited based on, and does not discriminate on the basis of:

• Race.

• Color.

• National origin.

• Disability.

• Age.

• Sex (including gender identity, sexual orientation, and pregnancy).

• Other constitutionally protected statuses.

Health disparities The goal of health equity is for everyone to have a fair and just opportunity to be as healthy as possible. Health disparities are often caused by social determinants of health. Social determinants of health are conditions in the environments where people are born, live, learn, work, play, worship, and age.

These determinants affect a wide range of health, functioning, and quality-of-life outcomes and risks. They also influence which populations are most affected by health conditions.

A health disparity is a difference in health burdens between groups of people with differing social determinants of health.

We expect all proposed activities to affirm and advance health equity and an equitable, diverse, and inclusive workforce as core principles. In addition to the strategies and activities listed above, during your award, we may ask you to conduct activities consistent with local laws to:

• Address health disparities in access to and use of HIV and TB services.

• Reduce HIV and TB stigma and discrimination.

• Promote civil and human rights to improve health outcomes of people living with or at risk of HIV and TB.

• Make the workforce more inclusive.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 20 https://www.cdc.gov/about/priorities/why-is-addressing-sdoh-important.html?CDC_AAref_Val=https://www.cdc.gov/about/sdoh/index.html

Organizational capacity You must include a heading in your Project Narrative titled Organizational Capacity, under which you should include a brief description of your organizational capacity to carry out these strategies and activities.

You must also provide supporting documentation in your attachments. See the attachments section for full instructions.

Collaborations If funded, we will expect you to collaborate with:

• The Namibia MOHSS and NIP.

• Other CDC-funded implementing partners throughout Namibia, including any other organizations awarded under this NOFO.

• Multi-lateral partners including the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), and the Joint United Nations Programme on HIV/AIDS (UNAIDS).

• Other U.S. government PEPFAR implementing partners, including the Global Fund.

• Local universities and other training institutions.

We will provide technical assistance to you in program design, including helping you establish relationships with relevant stakeholders.

Through the PEPFAR program, CDC works with partners to help prevent HIV infection, provide life-saving treatment to people living with HIV, and reduce HIV-related deaths. We encourage our partners to collaborate with local organizations, U.S.-based organizations, and international partners. The goal of this collaboration is to complement efforts to lower costs, make programs more effective, sustain the gains, and accelerate progress towards the three UNAIDS 95-95-95 targets:

• At least 95% of people living with HIV know their HIV status.

• At least 95% of people who know their HIV status are on treatment.

• At least 95% of people on treatment have a suppressed viral load.

If you work with key populations as defined in PEPFAR’s annual COP/ROP Guidance, we will expect you to collaborate with them when designing, delivering, and monitoring HIV services.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 21

Data, monitoring, and evaluation CDC expectations CDC expects you to review, clean, and use routine performance data for program management. As a result, you should hold regular review meetings to discuss performance and use data to inform program quality improvement activities.

In your application budget, you should allocate at least 5% of funds for monitoring activities and 5% for evaluation activities. We will discuss these percentages and finalize them at or after award. These are estimates for the total funding over the 5-year project.

Required performance measures

Overview This program includes two types of indicators. These include:

• PEPFAR’s Monitoring, Evaluation, and Reporting (MER) indicators common to all awards. You can find additional information regarding MER reporting in the MER Guidance and resource materials, available at DATIM’s MER Indicator Reference Guides.

• Custom indicators that either we or you create. These monitor achievement of outcomes not directly measured by MER indicators.

These include process and outcome measures that directly correlate with the logic model.

The indicators shown below may change before award or in future years. For example, any gaps or unmet needs not fulfilled in the first year may affect the targets in later years.

MER indicators There are currently no MER indicators applicable for this NOFO, but that may change in future project years.

Custom indicators Below we show some anticipated custom indicators, targets, and reporting frequencies for the first year. You may also propose custom indicators.

• Number of governance and policy documents produced, revised, and in use to inform HIS implementation. [Target: 2; Reporting Frequency: Semi- Annual]

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 22 https://help.datim.org/hc/en-us/articles/360000084446-MER-Indicator-Reference-Guides

• Number of available integrated dashboards and datasets in the NDW for use by MOHSS and implementing partner staff. [Target: 2; Reporting Frequency: Semi-Annual]

• Percentage of health facilities accessing key reports and data from EMR systems to inform patient and program management. [Target: >70%;

Reporting Frequency: Quarterly]

• Percentage of HIS being tracked for system coverage and data quality.

[Target: >90%; Reporting Frequency: Quarterly]

• Percentage of national unique health identifier coverage amongst the ART treatment cohort. [Target: >25%; Reporting Frequency: Monthly]

• Percentage of selected HIS that have successfully demonstrated the integration of a national unique identifier. [Target: 25%; Reporting Frequency: Semi-Annual]

• Percentage of health facilities using the upgraded HIV EMR system.

[Target: 100%; Reporting Frequency: Monthly]

• Percentage of HIS with a capacity development plan developed and being implemented with and for MOHSS. [Target: 100%; Reporting Frequency:

Quarterly]

• Percentage of selected HIS that have successfully demonstrated data interoperability. [Target: 25%; Reporting Frequency: Semi-Annual]

• Percentage of health facilities where EMR to Lab HIS are interoperable and functional. [Target: 50%; Reporting Frequency: Semi-Annual]

Data sources for MER and custom indicators Data sources may include registers, tally sheets, electronic and paper patient records, quarterly progress reports, surveillance and survey reports, other program monitoring tools and data consolidated from the NDW.

Evaluation Below, we include examples of evaluation topics that we may expect you to answer through process, outcome, or economic evaluation. In your application, include at least one, but no more than three potential evaluation questions. We will expect you to conduct an end-term evaluation.

• Effect of capacity building strategy on MOHSS’s ability to lead development and maintenance of HIS: outcome evaluation.

• Facilitators and barriers to uptake of a national health unique identifier:

process evaluation.

Step 1: Review the Opportunity 23

Evaluation data sources Data sources may include registers, tally sheets, electronic and paper patient records, recipient progress reports, focus groups, in-depth interviews, surveys, and other program monitoring tools.

Dissemination of evaluation results Dissemination channels could include:

• Local and international conferences and forum abstract presentations.

• Conference poster displays.

• Manuscripts.

• Bulletins.

• Reports.

• Presentations to technical working groups and stakeholder meetings.

• Other approved products in print and electronic media.

The primary intended users of evaluation results and findings will be the wider program stakeholders.

CDC and stakeholders will use overall evaluation findings during the 5-year project period to share and implement key recommendations to strengthen program implementation and effectiveness, sustainability, and continued program improvement after the award ends.

All evaluation reports will be publicly available on PEPFAR resource sites.

Evaluation and performance measurement plan You must submit an initial draft of your evaluation and performance measurement plan with your application. You must submit a more detailed plan within the first six months of the award. See reporting.

As you develop your evaluation and performance measurement plan, align it with national, PEPFAR, and agency priorities as detailed in the NOFO. If awarded, we will work with you to finalize the plan and ensure it takes into account agreements made during COP/ROP planning.

Include the following elements in your evaluation and performance measurement plan.

Step 1: Review the Opportunity 24

Methods Describe how you will:

• Collect the performance measures.

• Respond to the evaluation topics.

• Use evaluation findings for continuous program quality improvement.

• Incorporate evaluation and performance measurement into planning, implementing, and reporting of project activities.

Additionally, explain:

• How findings will contribute to reducing or eliminating health disparities, as relevant.

• How key program partners will participate in the evaluation and performance measurement process.

• How feasible it will be to collect appropriate evaluation and performance data.

• How you will share evaluation findings with communities and populations of interest in a way that meets their needs.

• Other relevant information, such as performance measures you propose.

Evaluation activities You must carry out specific evaluation activities.

At least one evaluation must be carried out for each cooperative agreement during the course of funding. The evaluation can be:

• Process evaluation: Measures how the intervention was delivered, what worked and did not, the differences between the intended population and the population served, and access to the intervention.

• Outcome evaluation: Determines the effects of the intervention in the focus population, such as change in knowledge, attitudes, behavior, or capacity.

• Economic evaluation: Determines cost, cost drivers, cost effectiveness, efficiency, factors influencing economic behavior and choices, or the economic impact of interventions or activities to justify the investment.

Describe:

• The type of evaluations you will complete (process, outcome, and/or economic).

Step 1: Review the Opportunity 25

• Key evaluation questions these evaluations will address.

• Other information, such as measures and data sources.

Data management plan (DMP) For all public health data you plan to collect, a DMP is required. For a definition of “public health data” and other key information, see AR 25: Data Management and Access on our website.

You must submit an initial draft of your DMP with your application. You must submit a more detailed plan within the first six months of the award. See reporting.

Submit your initial DMP with your application and include:

• The data you will collect or generate and their sources.

• Any reasons why you cannot share this data with CDC. These could include legal, regulatory, policy, or technical reasons.

• Who can access the data and how you will protect and secure it.

• Data standards that explain what documentation released data will have.

That documentation should describe collection methods, what the data represent, and data limitations.

• Archival and long-term data preservation plans.

• How you will update the DMP as new information becomes available during the project. You will provide updates to the DMP in annual reports. For more information about CDC’s policy on the DMP, see Data Management and Access Requirement at CDC’s website.

In addition to the other requirements listed, also include:

• Cybersecurity plans.

• How you will protect personally identifiable information (PII) when you collect, store, transfer, and use this data.

• How you will remove information from the data that could reveal participants’ identities (de-identify the data) in intermediate and final data sets.

CDC and PEPFAR will inform you of data you need to share with us and how and when it should be shared.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 26 https://www.cdc.gov/grants/additional-requirements/ar-25.html https://www.cdc.gov/grants/additional-requirements/ar-25.html https://www.cdc.gov/grants/additional-requirements/ar-25.html https://www.cdc.gov/grants/additional-requirements/ar-25.html

Work plan You must provide a work plan for your project. The work plan connects your performance outcomes, strategies and activities, and measures. It provides more detail on how you will measure outcomes and processes.

You should provide a detailed work plan for the first year and a high-level work plan for later years.

Table: Sample format

Activities you will implement

Progress or process measures

From the data, monitoring, and evaluation section.

Relevant period of performance outcomes

From the logic model.

Responsible position or party

Funding component / completion date

Strategy 1:

1.

2.

3.

Strategy 2:

1.

2.

3.

Paperwork Reduction Act Any activities involving information collection from 10 or more individuals or organizations may require Paperwork Reduction Act (PRA) approval. The PRA requires review and approval of the information collection by the White House Office of Management and Budget. For further information to determine if a proposed activity requires PRA approval, contact your project officer. Collections include items like surveys and questionnaires. If you have collections requiring PRA approval, CDC is responsible for working with OMB to gain the approval.

For more information about CDC’s requirements under PRA see CDC Paperwork Reduction Act Compliance.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 27 https://www.cdc.gov/scientific-integrity/php/public-information-collection/ https://www.cdc.gov/scientific-integrity/php/public-information-collection/

Funding policies and limitations General policies

• Your budget is arranged in eight categories: salaries and wages, fringe benefits, consultant costs, equipment, supplies, travel, other, and contractual.

• You may use funds only for reasonable program purposes consistent with the award, its terms and conditions, and federal laws and regulations that apply to the award. If you have questions about this determination, ask the grants management officer.

• Generally, you may not use funds to purchase furniture or equipment.

Clearly identify and justify any such proposed spending in the budget.

• All requests for funds contained in the budget should be stated in U.S.

dollars.

• Cost increases due to changes in exchange rates are allowed if enough funding is available. If an increase in the exchange rate would reduce the scope of the project or cause you to need more federal funding, you must get prior approval for exchange rate fluctuations.

• Support beyond the first budget year will depend on:

◦ Appropriation of funds.

◦ Satisfactory progress in meeting your project’s objectives.

◦ A decision that continued funding is in the government’s best interest.

• If we receive more funding for this program, we will consider:

◦ Funding more applicants.

◦ Extending the period of performance.

◦ Awarding supplemental funding.

See also program-specific limitations.

Unallowable costs You may not use funds for:

• Research.

• Clinical care, except as allowed by law.

• Pre-award costs, unless we give you prior written approval.

• Other than for normal and recognized executive-legislative relationships:

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 28 https://www.law.cornell.edu/definitions/index.php?width=840&height=800&iframe=true&def_id=13f24ea1f961f5f0d14b87ec1b39b25f&term_occur=999&term_src=Title:45:Chapter:A:Subchapter:A:Part:75:Subpart:E:Subjgrp:39:75.440

◦ Publicity or propaganda purposes, including preparing, distributing, or using any material designed to support or defeat the enactment of legislation before any legislative body.

◦ The salary or expenses of any grant or contract recipient, or agent acting for such recipient, related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or executive order proposed or pending before any legislative body.

◦ See Anti-Lobbying Restrictions for CDC Recipients.

• Needle exchange programs.

For guidance on some types of costs that we restrict or do not allow, see 45 CFR part 75, General Provisions for Selected Items of Cost.

Indirect costs Indirect costs have a common or joint purpose across more than one project and cannot be easily separated by project. Learn more at CDC Budget Preparation Guidelines.

To charge indirect costs you can select one of two methods:

Method 1 — Approved rate. You currently have an indirect cost rate approved by your cognizant federal agency.

Provide a summary of the rate. Enclose a copy of the current approved rate agreement in your attachments.

Method 2 — De minimis rate. Per 2 CFR 200.414(f), if you have never received a negotiated indirect cost rate, you may elect to charge a de minimis rate. If you choose this method, costs included in the indirect cost pool must not be charged as direct costs.

This rate is 15% of modified total direct costs (MTDC). See 2 CFR 200.1 for the definition of MTDC. You can use this rate indefinitely.

Foreign organizations and foreign public entities Indirect costs on awards to foreign organizations and foreign public entities performed fully outside of the U.S. and its territories may be paid to support the costs of complying with federal requirements. This rate is fixed at eight percent of MTDC exclusive of tuition and related fees, direct expenditures for equipment, and subawards in excess of $25,000. Negotiated indirect costs may be paid to the American University, Beirut, and the World Health Organization.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 29 http://www.cdc.gov/grants/documents/Anti-Lobbying_Restrictions_for_CDC_Grantees_July_2012.pdf https://www.ecfr.gov/current/title-45/part-75/subject-group-ECFR5d90ba314caea08 https://www.cdc.gov/grants/documents/budget-preparation-guidance.pdf https://www.cdc.gov/grants/documents/budget-preparation-guidance.pdf https://www.ecfr.gov/current/title-2/section-200.414 https://www.ecfr.gov/current/title-2/part-200#p-200.1(Modified%20Total%20Direct%20Cost%20(MTDC))

Other indirect cost policies

• As described in 45 CFR 75.403(d), you must consistently charge items as either indirect or direct costs and may not double charge.

• Indirect costs may include the cost of collecting, managing, sharing, and preserving data.

Salary rate limitation As of January 2024, the HHS/CDC salary rate limitation is $221,900. This salary rate limitation does not apply to PEPFAR funds, which are part of an appropriation from the U.S. Department of State; but to the extent that HHS/ CDC funds are added to an award, this limitation applies. We will update this limitation in future years.

Program income Program income is money earned as a result of your award-supported project activities. You must use program income for the purposes and under the conditions of the award. Find more about program income at 45 CFR 75.307.

Program-specific limitations

CDC PEPFAR terms and conditions You can find a list of PEPFAR-specific terms and conditions on our website.

They apply to all PEPFAR awards, so we strongly encourage you to read them and ask questions if you need more information. These terms and conditions will apply if you are selected for an award so you should confirm that you are able to comply with them prior to applying.

Host country laws and regulations If funded, you are expected to follow applicable host country laws and regulations related to the strategies under this NOFO; if there are conflicts with this award, contact the Grants Management Officer.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 30 https://www.ecfr.gov/current/title-45/part-75#p-75.403(d) https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-D/subject-group-ECFR911e5e1a30bfbcb/section-75.307 https://www.cdc.gov/grants/documents/PEPFAR-Terms-and-Conditions.pdf

Step 2:

Get Ready to Apply

In this step

Get registered 32

Questions 33

Get registered You must be registered in both SAM.gov and Grants.gov to apply. You can review the requirements and get started on developing your application before your registrations are complete.

SAM.gov You must have an active account with SAM.gov. This includes having a Unique Entity Identifier (UEI). SAM.gov registration can take several weeks. Begin that process today.

To register, go to SAM.gov Entity Registration and select Get Started. From the same page, you can also select the Entity Registration Checklist for…